Cardiology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.

Question: Our cardiac surgeon performs the surgical procedure, while other cardiologists in our practice handle postoperative treatment. We append modifier -54 to the surgical code and modifier -55 to the cardiologist's postoperative care code. We were recently advised to append modifier -55 to the surgical code to identify postoperative care. Is this correct?

Delaware Subscriber

        Answer: Yes. Modifier -55 (postoperative management only) should be appended only to a surgical code, even though the term "postoperative management" does not refer to a surgical procedure and begins only after the surgery is completed.
 
The Physician Fee Schedule divides the percentage of RVUs into a procedure's  pre-, intra- and postoperative components. Many cardiac surgeries are assigned as follows: pre-op, 9 percent; intra-op, 84 percent; post-op, 7 percent.
 
Appending modifier -54 (surgical care only) to the surgical procedure tells the carrier that the cardiac surgeon performed only the intraoperative portion of the procedure. In such cases, it is likely the surgeon will receive 84 percent of the RVUs assigned to the procedure.
 
The cardiologist, meanwhile, reports the same surgical code with modifier -55 appended and receives 7 percent of the value of the procedure. The cardiologist can use an E/M code only if another problem is being treated, in which case modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) should be appended.
 
Note: Very few carriers will pay for preoperative management performed by another physician, even when modifier -56 (preoperative management only) is appropriately reported.